Manager Utilization Review

Site: Mass General Brigham Incorporated

 

Mass General Brigham relies on a wide range of professionals, including doctors, nurses, business people, tech experts, researchers, and systems analysts to advance our mission. As a not-for-profit, we support patient care, research, teaching, and community service, striving to provide exceptional care. We believe that high-performing teams drive groundbreaking medical discoveries and invite all applicants to join us and experience what it means to be part of Mass General Brigham.

 

The Opportunity

Compensation offered for this position is up to $200k+ dependent on level of experience.

Manages a department of utilization review professionals usually consisting of Registered Nurses, Social Workers and other paraprofessional roles. Develops and oversees policies and processes for the team and collaborates with other departments to improve the organization's utilization.

 

Job Summary

Primary Responsibilities:

-Manages team and related staff, including hiring, training, supervision, and performance management.
-Participates in policy and procedure review and development.
-Protects healthcare organization value by keeping information confidential, cautioning others regarding potential breaches.
-Maintains awareness of health insurance changes.
-Maintains compliance with regulation changes affecting utilization management.

 

What You'll Bring

Qualification Requirements:

• Bachelor's Degree Nursing

• Registered Nurse (RN) license

• 3+ years of Utilization Review experience

• 2+ years management experience

Preferred Skills:

• Master’s Degree Nursing

• Change management experience

• Integration experience

• Workday, UKG, Epic, NCG and/or InterQual experience

• Medical Necessity Appeals and Denials experience

• Peer to Peer experience

Additional Knowledge, Skills and Abilities:

• Excellent team communication skills.

• Strong interpersonal skills, with the ability to develop, motivate and inspire a team.

• Strong team player that is able to multitask with multiple interruptions in a deadline-intense environment.

• Identifying complex problems and reviewing related information to develop and evaluate options and implement solutions.

• Understanding the implications of new information for both current and future problem-solving and decision-making.

 

Schedule and Work Model

• Remote

• Full-time (40 hours) Monday through Friday, standard business hours with minimal weekend coverage

• Employees must use a stable, secure, and compliant workstation in a quiet environment. Teams video is required and must be accessed using MGB-provided equipment.

 

Remote

 

399 Revolution Drive

 

40

 

Regular

 

Day (United States of America)

 

Pay Range

$58,656.00 - $142,448.80/Annual

 

Grade

98TEMP

 

At Mass General Brigham, we believe in recognizing and rewarding the unique value each team member brings to our organization. Our approach to determining base pay is comprehensive, and any offer extended will take into account your skills, relevant experience if applicable, education, certifications and other essential factors. The base pay information provided offers an estimate based on the minimum job qualifications; however, it does not encompass all elements contributing to your total compensation package. In addition to competitive base pay, we offer comprehensive benefits, career advancement opportunities, differentials, premiums and bonuses as applicable and recognition programs designed to celebrate your contributions and support your professional growth. We invite you to apply, and our Talent Acquisition team will provide an overview of your potential compensation and benefits package.

 

0100 Mass General Brigham Incorporated is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religious creed, national origin, sex, age, gender identity, disability, sexual orientation, military service, genetic information, and/or other status protected under law. We will ensure that all individuals with a disability are provided a reasonable accommodation to participate in the job application or interview process, to perform essential job functions, and to receive other benefits and privileges of employment. To ensure reasonable accommodation for individuals protected by Section 503 of the Rehabilitation Act of 1973, the Vietnam Veteran’s Readjustment Act of 1974, and Title I of the Americans with Disabilities Act of 1990, applicants who require accommodation in the job application process may contact Human Resources at (857)-282-7642.

 

Mass General Brigham Competency Framework